Objectives are imperative to any organisation. Working without a clear objective not only means measuring your success is at best subjective it can badly hit morale and drive. Imagine going into work and not knowing what you’re working towards.

Ohh, shiny!

Digital can be particularly prone to working without objectives as new and shiny tools excite and enthuse people to work towards a self-determined goal, e.g. ‘I want a website with integrated Twitter and YouTube content’. Lack of understanding of what digital can do can hamper senior decision makers ability to see whether one digital activity/project compared to the next is adding any value. Both things add to the opportunity for digital projects to slip pass the usual tests of:

Is this adding value to the organisation?

Is this an efficient use of our finite time?

Aligning digital to organisation objectives

If digital teams are to show their organisations they are worth the salary, digital teams have to be working towards the same goals as the organisation.

It bears repeating…

If digital teams are to show their organisations they are worth the salary, digital teams have to be working towards the same goals as the organisation.

It’s a question of getting the right individuals together who understand the limits that statement puts on them collectively. There may be a guy or girl who loves making videos, but if videos aren’t passing the above two tests then they shouldn’t be making videos. The approach brings with it good conflict – valuable conversations about personal goals, learning discipline and efficient use of capacity across the team.

An NHS example

A colleague in a Foundation Trust who enjoys working with Twitter wants to create some additional tweets to the numerous ones sent through by the national campaigns team. It will take them an hour of their 37.5 hours a week.

Will the tweets add value to the organisations? Is producing them an efficient use of the individuals time?

If the tweets are going to direct people to local services and/or start up a local conversation I’d say it does. If not that hour could be used to create other tweets which supported an organisational objective. For example:

Organisational objective = increase awareness of our safety record with the local population (as measured against the yearly ‘Do you think hospital X is as safe, safer or less safe than other NHS hospitals?’ question).

Alignment with organisational objective = a series of tweets to be used across the year that highlight the best safety aspects of hospital x and how the hospital is improving its safety record.

Management’s job

This simple writing tweets in one hour example shows how a good manager can turn a person’s motivation towards the common good of the organisation. It’s a tough job.

A good digital manager will be able to turn around to their boss and show how the team’s work has supported the achievement of organisational objectives; not just reel off a bunch of outputs. This is where the value of digital really starts to show itself. This is how digital teams can get investment and influence. This is along with Tim’s 10 mantras is a map to the future of digital.

Communications and lack there of has be a consistent problem during the last two years of NHS reform. The Department of Health hasn’t been able to find a lead spokesperson to outline in easy to understand language the huge challenge of changing the way the NHS operates. And there has been a lack of understanding from all parts of government and the NHS (bar the NHS Confederation in the last few months, in my opinion) of the need to take time to build up the case for change with the public, NHS staff and the media.

Andrew Lansley’s approach to the reforms helped propagate these issues, so will Jeremy Hunt help reverse some of the communication problems?

The consensus seems to be that Hunt as the better, smoother communicator is able to reverse the comms problems but has no understanding of the thing he is now trying to communicate. As Paul Corrigan rather politically put it on his blog:

“The appointment of the new secretary of state for health is a move away from someone who had a single idea about a policy to reform the NHS but could not communicate it (Andrew Lansley), to one that has no idea about NHS policy but communicates that very well – Jeremy Hunt.”

His implementation record during the Olympics and Paralympics is being flagged as proof of his abilities. Let us not forget however with the NHS we’re talking about the largest employer in Europe with 1 million+ staff spread over 400+ organisations all holding onto their slice of roughly £105bn of funding as the turbulent seas of reform buffet them from job matching to redundancy to opportunity and back again. Two, two week sporting events pale in comparison; as do the number of acronyms.

Olympic and Paralympic acronyms

NHS acronyms

ORN, PRN, LOCOG

CCG, CSU, PCT, HEE, PHE, AHSN, FT, QuOF, QIPP and on and on…

Digitally speaking Hunt has a Twitter account, something Lansley wisely opted out off, and has just witnessed digital comms at its most persuasive and pervasive during the Olympics; the first social games. Will this help him see the full suite of digital communucations as one way of the DH and NHS leadership building trust with NHS staff and the public? Hopefully so.

However, if the government wants health to quieten down then I doubt digital will get the step up I’d like it to.

As a stab in the dark, if I was in his position I would go with something along the lines of:

“We’ve all be dumped with this set of reforms. We must now enact the law. I want to work with you all to ensure we make these reforms as good for patients and the general public as possible.

I will take the next four weeks to understand my brief in depth and hear your thoughts on how we can get the best of these reforms. Please write to me or leave a comment at [link].”

Perhaps that is a naive view of political life, but I know that would resonate with my NHS colleagues more so that any of Lansley’s communications ever did.

Hunt has two years or less to implement the reforms before the election. He can either do it with or without communications. But only one of them has the potential to deliver a committed and supported change for the good of our nation’s health.

In short this guidance looks at whether or not nurses should be using their own phones while at work. The answer from the RCN is no, something I wholeheartedly agree with. Why should an employee have to meet the costs of a job they are employed to do and potentially divulge a personal mobile number in the process?

A look at some of the details

It may be a little picky but I’m disappointed not to see ‘and opportunities’ include in this sentence from the very first paragraph of the guidance:

“…as with the introduction of any technological innovation, new issues [and opportunities] have been raised by mobile phone use in health and social care.”

That aside I was very pleased to read throughout the guidance a tone of understanding about the potential benefit to staff and patient a mobile phone can bring.

Opportunities

Making up for the earlier omission of opportunities the RCN do include a useful list on page three of the benefits of mobile phones. A couple additions I would have added would be continuous professional development and communities of interest but overall it’s a good list and I’ve replicated it below:

The benfits of a mobile phone to staff and patients in health and social care

communication via telephone, SMS text

messaging and email

photography, for example, of patients’ wounds or skin condition

basic tools such as calculator and stopwatch

internet/intranet usage to access guidelines and other knowledge sources

downloadable apps designed for specific purposes

use of global positioning system (GPS) software for getting directions or calculating mileage, and for protection purposes by tracking the location of lone working nursing staff.

[Continuous professional development via access to online and app-based courses]

[Joining communities of interest to share knowledge and solve problems]

A comment on publishing timelines

The report was published on 22 August 2012, yet there are only two references from after 2010, both 2011 RCN reports. There are no references from 2012. In fact the large majority of the online references were accessed on 21 March 2011, nearly 18 months before publishing the report.

In the field of mobile technology 18 months is a long time.

The guidance is flagged for review in July 2014. I would have preferred to see July 2013 for this area of guidance.

Perhaps the RCN guidance needs to be even more dynamic and be reviewed every quarter to keep up with mobile technology? Is there someone within the RCN who would be willing and funded to keep abreast of the subject area all year round?

Conclusion

Overall, I think this is a measured and open minded piece of guidance and well worth a read for an insight into community nurses’ work.

I fear though that nurses on the ground will face a tough road to getting a work phone that is useable, secure and technically able to take full advantage of what an internet enabled phone offers.

As usual local autonomy on policies covering this area in place of a national top-down policy brings its own difficulties.

The NCB, as new official leader of the NHS from October 2012, has set itself the goal of being an open and transparent organisation, setting the tone for the rest of the NHS on publishing data and risk registers, and answering the public’s questions (see Roz Davies blog post as one example). So does the policy stand up to that ideal?

Pre-moderation of comments

Why is it a pre-moderation policy? As the BBC clearly sets out in its editorial guidelines post-moderation and reactive moderation were two of the more open and transparent options available to the NCB.

By not publishing any comments before moderation the NCB risks slowing the flow of discussion.

Does it show that in the soft under belly of the NCB there remains a worry that people might say what they think in unkind terms? Do they not trust other commenters to correct others mistakes or rants? Or it is just that they don’t think they’ve the manpower or hours to skim the comments and moderate any that break the rules? If it’s the last one, fair enough… just.

Additional delays

Why delay comments being published in order to answer them as this section alludes to: “Sometimes there is a delay in publishing whilst we seek information from various sources to be included in our response to questions.” let the discussion flow don’t stall it. Then go back with answers when you have them.

Stay on topic

Posting ‘on topic’ (bullet point one in the approval checklist) is subjective.

I think that some constant complainers about one thing or another – you know the type, the people you see on every comment stream who quickly turn a point of view towards the chip on their shoulder, that these people will not get their comments published and therefore will get ever angrier bringing more pain to the comms team instead of less. Let them have their off-topic moment.

Sharing is caring

What is this… “don’t reveal personal details, such as private addresses, phone numbers, email addresses or other online contact details”?!

Clear enough on the personal details part but what about the online contact details? So, no Twitter handle, no email address, no blog? How are people going to network via the comments and build up communities of interest and knowledge?

A lot of sites ask you to sign in to a service before commenting. Why haven’t the NCB followed up their desire to use social media well with a social commenting function?

NB: It is required to give the NCB an email address to be able to post a comment.

It ain’t all bad…

I thought the following section was a stroke of genius:

“NHS CBA Staff Tweeting

Some NHS CBA staff tweet under their own names or pseudonyms. Despite their professional affiliation with the NHS CBA, their tweets do not represent the official position of the Board, and should be considered the product of each individual as a private citizen.”

Great idea, very clear and a positive step allowing staff to maintain or start a Twitter account (and hopefully other social media accounts) will at the NCB. NHS Trusts take note.

Conclusion

Overall this isn’t a bad policy, and the fact they have one is super. It sounds to me that they haven’t completely shaken off the worries about what the public could say in the comments. Perhaps in six months the policy will be updated based on their experiences. Let’s hope so.

Success or failure of the strategy rests entirely on the IT underpinning it. Information technology that:

enables people to change smoothly (i.e. doesn’t put up barriers)

enables digital by default publication of information

includes software that doesn’t need a Masters in computational mathematics and computer science to use it.

So how to go about laying down those exacting foundations? The Government Digital Service has blogged on procuring the right systems across government and it is highly applicable to the NHS too – Chris Chant’s post ‘The Unacceptable‘ is a breath of fresh air, and make sure you read his follow up, ‘SMEs – we need to talk‘.

Onto championing…

The NHS revolves around its patients. Staff in patient facing and non-facing roles ensuring patients receive the best possible care is the main driving force behind the continued success of the NHS. This is the key to championing IT in the NHS.

Ask yourself, “How can this IT solution improve patient care and experience?“. If you take this with you as you show colleagues what is possible with good IT I don’t think you’ll go far wrong.

And finally…

All healthcare staff must take with them to work an understanding of IT. If we aren’t aware of what is possible we’ll never create the pressure for change. Is your work computer as good as your 3 year old laptop at home? If it is I applaud your organisation!

By working with your IT colleagues to make sure future procurement decisions are based on end user need and not the past you can start on the road to fulfilling the information strategy’s vision.

In my experience a good IT system leads to happy staff, and happy staff are best for patients.

Unfortunately a meeting today will stop me from joining in the oddly but hopefully not ironically hashtagged #HSJtwitchat. So here are a few things reading the Cogitamus report made me think about.

Section four (thought leadership) is absolutely key

I don’t think this can be overstated. In my three years in the NHS nothing, other than the statutory reforms, has lead to change not matter how big or small without leaders championing the cause. Having a range of individuals who can lead the discussion, provide viewpoints, evidence and counterpoints to detractors enables the rest of staff to see the need for change and start to work towards it.

Who ‘owns’ social media

This question breaks down into control of what is said and control of publishing.

Communications teams role is to be the hub of expertise on how these things work, interact, damage and improve. They should be enablers. They can’t own the social media brand but they can lead it.

Social media is here to stay

This will be said time and again. The point being that this has reminded me that social media practitioners across all organisations surveyed are coalescing around this point and are realising its implications.

If social media is here to stay then for organisations to take advantage of its benefits it needs resource, capacity and capability given to it. How is the NHS going to build these things around social media (whatever platforms exist now and in the future) when comms teams are being decreased in size and social media expertise is spread thinly across it’s 1 million plus staff?

I can’t make tonight’s #nhssm chat on ‘Staff social media engagement: what are the barriers and how to overcome them’ so I’ve written the below to help me think it through. Hopefully it can add a little to the chat too. Then again I may have got completely the wrong end of the stick!

Telling the world what you organisation does

Social media gives the organisation and staff a free publishing tool with the potential to reach a number of targeted people, e.g. local councillors, the local paper, and local people.

I find showing staff how social media can help promote the work they are passionate in is often a good way of introducing them to new channels.

Helping staff understand how the organisation’s is perceived

All communications teams should be constantly horizon scanning and picking up on how the organisation is perceived outside of their four walls.

While this is a basic comms rule very often the information gathered doesn’t get much further than the comms team. By bringing social media in to the four walls of the organisation you can help educate people as to how the organisation and their work is seen, why it’s seen that way and how to maintain or improve that perception.

A round up of tweets to relevant teams by week (if you have enough to do that) or just passing on positive and negative tweets to teams would be a big start. A Twitter feed of mentions on the intranet is a good one, but can run into problems with people wanting to moderate which tweets appear.

Enabling staff to make better decisions at work

On both the commissioning and provider sides of the NHS social media offers people the chance to get customer feedback. If that feedback is negative it can be a good stepping stone to catalysing a discussion on what the service can do to improve. If it is positive it can help reinforce good service and behaviour.

But for now where I see the greatest gains to be made is on the commissioning side. By showing staff the wonders of the networked web and how it can bring useful information to them as they need it I see a time when commissioners aren’t sat together in a room with a few spreadsheets, but online with interactive maps, tweets bringing in relevant evidence and online discussion spreading best practice. That would be a giant leap toward evidence based decision making and continuous professional development via social media.

Over on the #nhssm blog we’re running #fluscenario – a speeded up version of 2009’s swine flu pandemic and asking you how you could help spread factual messages by using your online profile/social media accounts.

Social media has come a long way since 2009 and it has been interesting from my perspective to answer the questions including in the blog posts knowing that two years or more ago we would still have been hung up on whether doctors would be struck off for tweeting anything medical!

T’other day I went down to the South West of England to have a chat with comms leads from the regions hospitals about social media.

First and foremost, despite growing up round there the journey down there was a happily recieved reminder of the beauty of that part of the world. The pace of life is also different to London. Better than London in my eyes and more friendly of course. I digress….

All-round I felt the meeting was a success. People in the room were open and honest with their level of experience on social media and some great lessons and case studies came out of that.

For my part I was really motivated to hear how far down the road most people were with social media. 18 months ago it was all about getting executive sign off to use social media, or IT clearance for comms teams. Now I was hearing about how people have been building online communities and integrating social media into their media relations work for a few months or more.

Below are a few Q&As I picked up from the chat. Pardon the strange style it is copied and pasted from an email. I also apologise for breaking *all the blog post length rules*; bare with it I think there is some useful stuff hidden away in there for you all.

Questions and answers from a social media chat in the South West

Writing for the different platforms. This only comes with practise! I would take some time to look around at how people you follow/are friends with are writing. What writing styles make you happy/sad/annoyed, click on a link, RT a tweet, like a post? How can you use those styles in your work? Using active verbs and plain English are obviously a must.

Making your organisation’s news more topical. The key here is to join in with region-wide and national topics. For example, the PiP implant scandal – what could your hospital say to its followers about it? Could you RT the DH info? Remember it needn’t be original content all the time with social media.

Increasing Twitter followers is an odd game. There is little use in using follower number as a marker of quality. You could have 2,000 followers but no real influence or interaction. On the other hand you could have 10 local bloggers follow you who subsequently blog about your organisation news and help you get your messages out to the local population. Don’t fret about follower numbers. Here are a few tips to increase the number over time:

Tweet regularly. The nature of Twitter means the more active you are the more chance people have of coming across you.

Network with your local public sector organisations and get them to RT your tweets, RT theirs in return.

RT local people and organisation tweets (you may want to think about a Twitter policy which makes it clear a RT doesn’t equal support)

Join in on local hashtags. Is there a local tweetup (online or offline meet up of people on Twitter) you could join?

Increasing conversations online. Activity and topicality is key here. People won’t talk to a silent account much and it’s difficult to get people to talk about something they aren’t interested in. What issues and concerns are in your area? Perhaps maternity service redesign… in which case can you tweet/update Facebook with news of the proposals, consultation, key dates and facts? Your organisation will of course cop some flack but that is the role of comms. If we’re doing it right we can then feedback the concerns of online followers to the appropriate clinicians and managers in inform the decision making process. Finally, don’t try and lead the conversation all the time, go looking for others’ active conversations about health and join in.

Capacity issues with a 1.5 WTE team. The key here is to remember the broadcast-reactive stages of my ‘sliding scale of [online] conversation’ diagram (below). Don’t try and do it all online. Just maintain a presence. This can be done easily using scheduling functions on Twitter (TweetDeck (software) and Twuffer.com (website) offer scheduling functionality). Perhaps you can plan the weekend and next weeks content on Twitter on Friday and schedule it in. Facebook updates should follow your press releases at this stage, just remember to personalise the content a little for Facebook’s very personal life culture. A friend of mine checks Twitter and Facebook for notifications each hour, it takes him two minutes (roughly 15 mins a day). He only uses more time when someone has interacted with the organisation’s profiles.

You won’t get left behind. Use your networks around the NHS to get updates on future social media ideas etc.

The colleague with the control of social media, you with little understanding of what goes on there. I’ll be honest, this scared me a little. If the comms lead hasn’t got an understanding of what is going out under the organisation’s name and brand there is a risk of issues arising. A weekly check-in of what is planned to go out and a daily 5 min update on any interactions on Twitter/Facebook would be useful to make sure you know what is ongoing and help you understand how the platforms work. No need to be an expert, just know enough so you can explain it to a director if something does go well or badly online.

Video quality. My personal opinion on this is that it is not worth us spending money on high-end broadcast quality video. News outlets around the world are now regularly screening mobile footage and Skype interviews. The public are used to slightly lower quality video. It is the content that counts. You can have perfect HD head and shoulder shots of a CEO banging on about what’s important but it is still boring to most people! This excellent urology robot example proves that. Save the money and spend it on training your staff in how to use a basic flipcam/digital camera and buy a cheap piece of editing software.

Social media turning into too much of a customer service channel. This is a tough one. There is the balance between reputational risk and wasting capacity. If I were to be cynical I would say treat the people with large and or influential online followings like customers and people with 10 followers less so. Shocking but one school of thought. This question also brings into focus the issue of teaching PALS teams to use social media and perhaps providing a suggestions and complaints specific Twitter account for people to contact.

Finally on this, remember the invention of emails allowing people to directly email the CEO? Twitter may follow the same grain, a busy start, slowing as people (who are more reasonable than we sometimes recall) realise Twitter isn’t the right channel to complain on. #waitandsee.

Apps. This most definitely should be done at a national level. If you are to look at it remember apps shouldn’t be costing £10,000+. They are quick and easy to produce for people with programming knowledge. Is there anyone in the NHS system in your region who could help you? Could your team provide the service to other acutes for a fee and start to satisfy the need for more income generation? Philosophically a strange argument but something to think about.

IT issues – these often depend on local relationships. There may be some ground to be made in educating your IT colleagues as to the approach by other trusts in the South West.

Telling difficult stories online – In short – plan, plan, plan. Just the same at traditional comms and pr.

Twitter is now often the source of stories that get printed – how could you use Twitter as the hook for a boring story. #NHSXmas is a great example – we got a boring “don’t go to A&E when you aren’t dying/really ill or injured over Christmas” message into the London Evening Standard on the back of using Twitter.

The digital divide – SOCIAL MEDIA IS NOT REPLACING TRADITIONAL COMMS!! One day I will get a t-shirt printed with this on. It is merely being added to the toolbox. It is not the silver bullet to end all our comms problems. The traditional comms rules apply, particularly the go where the audience is one. You’re not going to communicate with me or the many people younger than me through quarterly magazines and leaflets.